4 CLINICAL PICTURE ADHD/ HKD core symptoms Inattention a 1. Often fails to give close attention to details, or makes careless mistakes in schoolwork, work, or other activities 2. Often has difficulty in sustaining attention in tasks or play activities 3. Often does not seem to listen when spoken to directly 4. Often fails to follow through on instructions or to finish schoolwork, chores, or duties in the workplace (not because of oppositional behaviour or failure to understand instructions) 4

5 CLINICAL PICTURE ADHD/ HKD core symptoms Inattention 5. Often has difficulty in organising tasks and activities 6. Often avoids, dislikes, or is reluctant to engage in, tasks that require sustained mental effort (such as schoolwork or homework) 7. Often loses things necessary for tasks or activities (eg toys, school assignments, pencils, books, or tools) 8. Is often easily distracted by extraneous stimuli 9. Is often forgetful in daily activities 5

6 CLINICAL PICTURE ADHD/ HKD core symptoms Hyperactivity 1. Often fidgets with hands or feet or squirms in seat 2. Often leaves seat in classroom or in other situations in which remaining seated is expected 3. Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, this may be limited to subjective feelings of restlessness) 4. Often has difficulty playing or engaging in leisure activities quietly 5. Often on the go or often acts as if driven by a motor. 6

7 CLINICAL PICTURE ADHD/ HKD core symptoms Impulsivity 1. Often blurts out answers before questions have been completed 2. Often has difficulty awaiting turn. Often interrupts or intrudes on others (eg butts into others' conversations or games) 3. Often talks excessively 4. Often interrupts or intrudes on others (e.g. butts into others' conversations or games) 7

9 Duration CLINICAL PICTURE Core symptoms Additional diagnostic criteria a Age of onset symptom criteria must have been met for the past 6 months some symptoms must have been present before 6-7 years of age Pervasiveness present in 2 or more settings (eg school, work or home) 9

10 Impairment symptoms must have led to significant impairment (social, academic, or occupational) Discrepancy symptoms are excessive in comparison to other children of the same age and IQ Exclusion CLINICAL PICTURE Core symptoms Additional diagnostic criteria symptoms must not be solely attributable to other mental disorders 10

16 CLINICAL PICTURE Core symptoms Diagnostic issues interpreter bias a Phrasing of core symptoms Interpretation of words such as often Interpretation of phrases such as significant impairment Discrepant information from different sources Investigator bias and training bias 16

17 Prevalence rates Bv. ADHD diagnostische cut-off The best estimate based on current DSM-IV criteria is a prevalence of 2-5% 17

18 Prevalence (%) EPIDEMIOLOGY Prevalence and impairment Prevalence is lower when impairment is considered Males without impairment considered Females without impairment considered Males & females without impairment considered Males & females with impairment considered AHCPR

33 Neuroscience-neuropsychologybehaviour / Development Possession of the DRD4 7-repeat allele was associated with a thinner right orbitofrontal/inferior prefrontal and posterior parietal cortex. Participants with ADHD carrying the DRD4 7-repeat allele had a better clinical outcome and a distinct trajectory of cortical development with normalization of the right parietal cortical region. Shaw ea 2007, Arch Gen Psychiatry 34

48 ASSESSMENT Behavioural observation ADHD may not be observable in highly structured settings in novel situations when patient is engaged in interesting activities when patient is receiving oneto-one attention in a controlled and supervised context where there are frequent rewards ADHD typically worsens in unstructured situations during repetitive activity in boring situations where there is a lot of distraction under minimal supervision when sustained attention or mental effort is required during self-paced activities Observation in varying contexts is important 53

54 Counceling Adjustment of the child, the family, teacher to the new situation Mourning for the lost ideal Adaptation of expectations Adaptation of environment Adaptation of reactions Treatment plan Identify treatment aims and priorities Directly related to ADHD Associated problems 59

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